Sleep-disordered breathing in patients with opioid use disorders in long-term maintenance on buprenorphine-naloxone: A case series

J Opioid Manag. 2015 Jul-Aug;11(4):363-6. doi: 10.5055/jom.2015.0285.

Abstract

Background: Rates of opioid overdose deaths are increasing in the United States, leading to intensified efforts to provide medication-assisted treatments for opioid use disorders. It is not clear what effect opioid agonist treatments (ie, the µ-opioid receptor full agonist methadone and the partial agonist buprenorphine) may have on respiratory function. However, sleep-disordered breathing has been documented in methadone maintenance pharmacotherapy, and there is emerging evidence for similar sleep-disordered breathing in buprenorphine and buprenorphine-naloxone maintenance treatment.

Objective: To provide further clinical evidence of sleep-disordered breathing emerging in the context of buprenorphine-naloxone maintenance pharmacotherapy.

Methods: The authors report two additional cases of sleep-disordered breathing that developed in patients with severe opioid use disorders, treated successfully as outpatients with buprenorphine-naloxone maintenance. Both patients provided written consent for their clinical information to be included in this case report, and elements of their identities have been masked to provide confidentiality.

Results: Two adult female patients, who were stable in buprenorphine-naloxone maintenance treatment developed daytime sleepiness, were referred for evaluation and found to have sleep-disordered breathing. One patient's daytime sleepiness improved with reduction in both buprenorphine-naloxone and other sedating medications as well as initiation of a constant positive airway pressure (CPAP) device. However, the other patient could not tolerate decreases in buprenorphine-naloxone and/or CPAP initiation and her daytime sleepiness persisted.

Conclusion: Buprenorphine-naloxone maintenance treatment can be associated with sleep-disordered breathing. It can be difficult to differentiate the cause(s) of sleep-disordered breathing among the effects of buprenorphine-naloxone treatment itself, co-occurring conditions, such as obesity and cigarette smoking or other medications, or some combination thereof. Regardless of etiology, sleep-disordered breathing and its consequences present unique challenges to the patient in recovery from an opioid use disorder and therefore warrants careful evaluation and management.

Publication types

  • Case Reports
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Buprenorphine / administration & dosage
  • Buprenorphine / adverse effects*
  • Diagnosis, Differential
  • Disease Management
  • Female
  • Humans
  • Middle Aged
  • Naloxone / administration & dosage
  • Naloxone / adverse effects*
  • Narcotic Antagonists / administration & dosage
  • Narcotic Antagonists / adverse effects
  • Opiate Substitution Treatment* / adverse effects
  • Opiate Substitution Treatment* / methods
  • Opioid-Related Disorders / therapy*
  • Positive-Pressure Respiration / methods
  • Sleep Apnea Syndromes* / diagnosis
  • Sleep Apnea Syndromes* / etiology
  • Sleep Apnea Syndromes* / therapy
  • Time
  • Withholding Treatment

Substances

  • Narcotic Antagonists
  • Naloxone
  • Buprenorphine